Nursing Elites

1. A client with asthma develops respiratory acidosis. Based on this diagnosis, what should the nurse expect the client's serum potassium level to be?

• A. normal
• B. elevated
• C. low
• D. unrelated to the pH

Correct answer: B

Rationale: In respiratory acidosis, the body retains CO2, leading to increased hydrogen ion concentration and a drop in blood pH. As pH decreases, serum potassium levels increase due to the movement of potassium out of cells to compensate for the acidosis. Elevated serum potassium levels are expected in respiratory acidosis. Choice A ('normal') is incorrect because potassium levels are expected to be elevated in respiratory acidosis. Choice C ('low') is incorrect as potassium levels rise in this condition. Choice D ('unrelated to the pH') is incorrect as serum potassium levels are directly impacted by changes in pH in respiratory acidosis.

2. The nurse is obtaining a health assessment from the preoperative client scheduled for hip replacement surgery. Which statement by the client would be most important for the nurse to report to the physician?

• A. "I had chickenpox when I was 8 years old."?
• B. "I had rheumatic fever when I was 10 years old."?
• C. "I have a strong family history of gastric cancer."?
• D. "I have pain in my hip with any movement."?

Correct answer: B

Rationale: The most important statement for the nurse to report to the physician is that the client had rheumatic fever when they were 10 years old. This information is crucial as individuals who have had rheumatic fever require pre-medication with antibiotics before any surgical or dental procedure to prevent bacterial endocarditis. Reporting this history ensures the client's safety during the hip replacement surgery. The other options, such as having chickenpox in the past, a family history of gastric cancer, or experiencing hip pain, are important for the client's overall health assessment but do not have the same immediate implications for the upcoming surgery as the history of rheumatic fever.

3. A client admitted with an episode of bleeding esophageal varices is receiving propranolol (Inderal LA). The nurse knows to monitor for?

• A. Hypertension
• B. Hyperkalemia
• C. Bradycardia
• D. Arthralgia

Correct answer: C

Rationale: The correct answer is 'Bradycardia.' Propranolol is a beta-blocking agent used to decrease the heart rate. In the case of bleeding esophageal varices, propranolol is given to reduce the risk of bleeding by keeping the heart rate around 55 beats per minute. Monitoring for bradycardia is essential as the medication's intended effect is to lower the heart rate. Choices A, B, and D are incorrect because propranolol would not typically cause hypertension, hyperkalemia, or arthralgia.

4. A healthcare professional is assessing a patient's right lower extremity. The extremity is warm to touch, red, and swollen. The patient is also running a low fever. Which of the following conditions would be the most likely cause of the patient's condition?

• A. Herpes
• B. Scleroderma
• C. Dermatitis
• D. Cellulitis

Correct answer: D

Rationale: The patient's presentation of a warm, red, swollen extremity with a low fever is indicative of cellulitis, which is inflammation of cellular tissue. Cellulitis is commonly associated with these symptoms due to a bacterial infection in the skin and underlying tissues. Herpes (Choice A) is a viral infection that typically presents with grouped vesicles, not the warm, red, swollen presentation seen in cellulitis. Scleroderma (Choice B) is a chronic autoimmune condition affecting the skin and connective tissue, presenting differently from the acute symptoms of cellulitis. Dermatitis (Choice C) refers to skin inflammation, which does not typically present with the described symptoms of warmth, redness, swelling, and low fever observed in cellulitis.

5. While undergoing hemodialysis, the client becomes restless and tells the nurse he has a headache and feels nauseous. Which of the following complications does the nurse suspect?

• A. Infection.
• B. Disequilibrium syndrome.
• C. Air embolus.
• D. Infection.

Correct answer: C

Rationale: In this scenario, the client undergoing hemodialysis is experiencing symptoms like restlessness, a headache, and nausea. These symptoms are indicative of an air embolus, a serious complication that can occur during hemodialysis. Air embolus happens when air enters the bloodstream and can lead to symptoms like restlessness, a headache, and nausea. It is crucial for the nurse to suspect and address this complication promptly to prevent further harm to the client. Choices A and D (Infection) are less likely in this case, as the symptoms presented are more suggestive of an air embolus rather than an infection. Choice B (Disequilibrium syndrome) is also less likely as the symptoms described are not typical of this syndrome. Therefore, the correct answer is C: Air embolus.

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